Posted tagged ‘infants’

Can sitting or standing hurt a young baby’s bones?

May 2, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Desiree wanted to know: “Is it true that putting an infant (2-4 month old, before they can sit unassisted) in a sitting position can damage their spine? I’ve read posts by people about this but don’t know how much truth there is. Assuming child can hold head up enough to be able to ‘sit’ on someone’s lap or on a sitting device for relatively short periods of time? Is there a limit to how long this should be or that it becomes dangerous?”

Little babies love to master new things. And they have fun doing it, too—their eyes sparkle when they learn to stand in your lap, or when they sit up with a little help to see the whole world. When they’re lying down on the floor or their bed they can only see the ceiling. Where’s the fun in that?

Their little minds and bodies are made to grow and develop and try new things. Spending time on their tummies helps babies develop muscles in the front of their chests, and helps practice the coordination to lift their heads and look around. Time sitting up exercises different muscles, too. And bones themselves grow and develop based on the stresses and loads that they feel—so, yes, standing up is a good thing to help babies grow stronger and more confident of their skills.

A few caveats – keep a little common sense in mind. Those gizmos that help babies sit up are fine, but not if you put them on top of a table or counter. They can still topple out of them, so never use them on a raised surface. Also, a baby has to be able to hold his or her head up unsupported to stay in an upright position.

Is there a limit to how long babies should try these new positions? Sure – let the babies tell you. If it starts to hurt, they’ll get upset, and that’s when you’ll pick them up or move them or try a new activity. If bones are being “damaged” by the stress of a new activity, they’ll hurt, and you’ll know it. That’s why people feel pain when they should stop doing something. Babies are very good at telling you when something hurts.

They’re also very good at telling you when they’re happy. So help your baby learn new things and try new ways of standing, sitting, and getting around. Have fun!

This is a baby

Is Tummy Time really essential?

March 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Fiona has had it with “Tummy Time”! She wrote: “Doctors, prenatal classes, books, other Mums all stress that it’s vital for preventing a flat head and strengthening muscles.  But my little monkey screams blue murder the second I put her on her tummy.  What’s the evidence behind this (fairly recent?) exhortation to put babies on their tummies for a few minutes every day? Have people always done it, and if not, were kids in times gone by somehow delayed in their motor development? My instinct says no, but the call for tummy time seems to be so ubiquitous. And if it’s so important, how do we convince the babies who resist? Mine spends much of her awake hours sitting upright in a sling so I guess she gets a neck workout that way and isn’t lying on her back all the time risking flat-headedness, but it’d be nice to be reassured!”

Tummy time isn’t supposed to be “torture time.” If your baby absolutely hates it, pick her up. There’s no great evidence that it’s necessary at all.

The growing enthusiasm for tummy time began with recommendations in the 1990s that babies be put down to sleep on their backs, rather than their tummies. This led to a dramatic drop in deaths from SIDS, but an increase in what’s formally known as “positional plagiocephaly”, or flat little heads. It turns out that when Junior sleeps on her back, especially with her head turned to the same side all the time, that side gets kind of flatter. There’s no significant medical issue here—heads flattened in this manner don’t cause brain damage or developmental problems—but in severe cases it can be noticeable.

There are good ways to prevent flat heads. The AAP recommends alternating head positions from night to night, and periodically changing around the positioning of the crib so interesting things aren’t always in the same position (you can accomplish the same things by alternating which end of the crib is “up”, or which end the head and feet point to.) And, yes, as part of the anti-flat-head routine, the AAP recommends “a certain amount” of supervised “tummy time” when Junior is awake. They acknowledge that there’s no evidence that this helps, and no studies have shown how much tummy time is ideal, or at what ages it’s needed. It’s more of a common-sense thing. More time on tummy means less time on back, which should not only prevent flat heads but also facilitate motor development by giving Junior a chance to work on her push-ups. So for the many babies who don’t mind some tummy time, I think it’s probably a good idea.

If you’ve got a baby who’s starting to look a little flat in the head department, talk with your pediatrician. Re-orient the crib to encourage Junior to look the other way, and try to alternate head positions and increase tummy time. Your pediatrician should also check for torticollis, a muscular condition that makes in difficult for babies to turn their heads in both directions. Rarely, a molding helmet can be used to help heads grow more round in shape, but beware that companies are marketing these directly to parents, and many babies with mild asymmetry really don’t need anything special, just some repositioning and time to grow and develop.

But for babies like Fiona’s, who absolutely hate tummy time, there’s no reason to think it’s critical. I’d try to make tummy time more fun, if possible, by lying down with the baby so she could see me. But bottom line: if she’s hysterical, pick her up. This issue is not worth any misery.